The distribution of antibiotic use and its association with antibiotic resistance
- Harvard TH Chan School of Public Health, United States
- University of Toronto, Canada
- Boston Children's Hospital, United States
Abstract
Antibiotic use is a primary driver of antibiotic resistance. However, antibiotic use can be distributed in different ways in a population, and the association between the distribution of use and antibiotic resistance has not been explored. Here we tested the hypothesis that repeated use of antibiotics has a stronger association with population-wide antibiotic resistance than broadly-distributed, low-intensity use. First, we characterized the distribution of outpatient antibiotic use across US states, finding that antibiotic use is uneven and that repeated use of antibiotics makes up a minority of antibiotic use. Second, we compared antibiotic use with resistance for 72 pathogen-antibiotic combinations across states. Finally, having partitioned total use into extensive and intensive margins, we found that intense use had a weaker association with resistance than extensive use. If the use-resistance relationship is causal, these results suggest that reducing total use and selection intensity will require reducing broadly-distributed, low-intensity use.
Data availability
State-level, aggregate antibiotic use and resistance data used in the main analyses are in Figure 3 - Source data 1 and 2. We do not own and cannot publish disaggregated MarketScan or Medicare data. MarketScan data are available by commercial license from Truven Health (marketscan.truvenhealth.com). Medicare data are available from ResDAC (www.resdac.org). ResDAC requires an application ensuring that requesting researchers comply with Common Rule, HIPAA, and CMS security and privacy requirements. Disaggregated ResistanceOpen data are restricted due to hospitals' privacy concerns. ResistanceOpen data are available by request from HealthMap (www.resistanceopen.org).
Article and author information
Author details
Funding
National Institute of General Medical Sciences (U54GM088558)
- Scott W Olesen
- Marc Lipsitch
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Copyright
© 2018, Olesen et al.
This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.
Metrics
-
- 12,836
- views
-
- 1,467
- downloads
-
- 167
- citations
Views, downloads and citations are aggregated across all versions of this paper published by eLife.
Citations by DOI
-
- 167
- citations for umbrella DOI https://doi.org/10.7554/eLife.39435
Download links
A two-part list of links to download the article, or parts of the article, in various formats.
Downloads (link to download the article as PDF)
Open citations (links to open the citations from this article in various online reference manager services)
Cite this article (links to download the citations from this article in formats compatible with various reference manager tools)
The distribution of antibiotic use and its association with antibiotic resistance
eLife 7:e39435.
https://doi.org/10.7554/eLife.39435
Further reading
-
- Epidemiology and Global Health
- Microbiology and Infectious Disease
We are writing to reply to the comment by Pouwels et al., 2019 about our recent study (Olesen et al., 2018) on antibiotic use and antibiotic resistance.
